This post is going to contradict most of what we generally preach about enterprise imaging. Typically, the goal of enterprise imaging is to increase the availability of any medical image for any member of the care team, and that is appropriate in most cases. However, some images are more sensitive and shouldn’t be shared with every clinician. Instead, these images must be restricted and made available only to a very limited number of care providers based on their role in the patient’s care. An optimal enterprise imaging solution supports workflows that protect this sensitive, restricted content.
Some of this sensitive content includes graphic images that may disturb people who aren’t expecting them. Examples can include graphic photos of wounds, nudity, or abuse victims. One of the most frequent requests for managing access to restricted content relates to abuse victims. Images of children who have been abused or neglected are especially sensitive. Rape victims and subjects of domestic violence are other examples of patients whose data should be closely guarded, especially when friends or family members may be hospital employees and would otherwise have access to those records. Another class of patients who often warrant additional privacy is VIPs. Local dignitaries, celebrities, and politicians often seek treatment for issues such as depression, substance abuse, or cosmetic surgery that they don’t want publicized. Additionally, lawsuits and fines related to HIPAA data breaches can be financially damaging and tarnish the organization’s image in the local market.
For these reasons, it’s vital that an enterprise imaging solution has tools in place to protect these records. When a suspected victim of child abuse or neglect shows up in the emergency department, it’s crucial that hospital staff can identify the concern and document all evidence needed. That includes images used by community agencies and law enforcement to ensure patient safety and maintain privacy.
Data security has always been a foundational element of Synapse® VNA; its patented, hierarchical org structure is designed to provide data segregation and controlled access. Its robust audit trail also ensures the custody chain is clearly documented.
Modern workflows are also enhanced by additional tools that support more granular controls. Synapse VNA lets the user flag individual records as sensitive or restricted. If the Plastics department considers everything they capture to be sensitive, as nudity is often involved, Synapse VNA can flag the entire department. Abuse victims may be seen by multiple specialties, so the VNA also supports flagging all content for the patient. Additionally, users can flag individual studies, groups of studies, and folders of images that include DICOM and specialty (non-DICOM) imaging.
One of the most important aspects in caring for victims is documenting evidence of the abuse. Stanford Medicine provides extensive guidance on what should be documented in suspected child abuse and neglect (SCAN) cases. Connext Mobile, FUJIFILM Healthcare Americas Corporation’s mobile app, lets the user capture images, videos, audio, and text notes at the point of care. This is ideal for workflows that require taking photos of the victim’s face and body as evidence of bodily harm. The audio and video features can be used to record the patient (e.g., the abused child) and any witnesses or family members describing the abuse in their own words so there is no risk of misinterpretation later. This is recommended by Stanford for child abuse, domestic abuse, and elder abuse.
Clinicians can flag content as sensitive or restricted while capturing it in Connext Mobile as part of a routine encounter and not specifically as it relates to the abuse. If a patient is admitted for another reason and the provider notices evidence of abuse, it’s easy to create an additional folder to document the abuse to ensure vital information is immediately captured. Synapse VNA can also include forms or checklists. This makes it easy for those reporting the abuse to document everything necessary to support the legal health record. Safety, Care and Nurturing (SCAN) departments can create a series of questions that users must answer when documenting the case. Questions can be optional or required, and users can be offered a drop-down list with frequently used responses to make it quick and easy to complete. The goal is to capture all the necessary information without adding unnecessary burden on the caregiver.
Many facilities only want a small number of staff members to have access to restricted abuse photos. Synapse VNA supports configurations where multiple staff members can capture the photos and mark them as restricted. Once uploaded to the VNA, only staff with an explicit “view restricted” permission may then access those images. The system can also be configured so that all content stored in a specific department or related to an individual patient is restricted. For example, X-rays and other specialty imaging related to the abuse can automatically be flagged as restricted. These images can also easily be exported for use by law enforcement.
For more-typical VIP patient workflows, the sensitive and restricted flags on patients and departments are compatible with the Connext encounters-based worklists. In fact, unless the user has “view restricted” permission, they won’t be able see worklist entries for restricted patients. This helps ensure privacy for even the most sensitive guests.
Want to learn more about how Synapse VNA protects sensitive content within the archive? Click here to schedule a one-on-one with one of our product specialists.